Coronary artery spasm induced by carotid sinus stimulation during arthroscopic shoulder surgery

Abstract

Rationale: Variant angina is characterized by coronary artery spasm irrespective of the presence of fixed stenotic coronary lesions. Perioperative coronary artery spasm may be induced by the supersensitivity of vascular smooth muscle cells caused by various stimuli, including stimulation of the parasympathetic nervous system. Patient concerns: A 57-year-old male patient was undergoing arthroscopic rotator cuff repair under combined interscalene brachial plexus block and general anesthesia in the lateral decubitus position. While compressing the right shoulder to remove residual irrigation fluid in the shoulder through the surgical site, ventricular fibrillation occurred without ST elevation. Interventions: The patient achieved a return of spontaneous circulation after chest compression, defibrillation, and an epinephrine infusion. Diagnosis: Postoperative coronary angiography showed no significant stenosis, but it did show that the right coronary artery contracted rapidly and was completely obstructed after an intravascular injection of ergonovine, and that the contracted area returned to its normal size after nitroglycerin was injected into the coronary artery. Based on these observations, the patient was diagnosed with variant angina. Outcomes: The patient was discharged on postoperative day 20 without any sequelae and is currently under follow-up in the Cardiology Department. Lessons: Surgeons should be vigilant and take relevant precautions, as compressing the shoulder to remove residual irrigation fluid during arthroscopic shoulder surgery in the lateral decubitus position may stimulate the carotid sinus and cause coronary artery spasm.